Chapter 8
Nutrition

What should you eat to stay healthy?

Hardly a day goes by without someone trying to answer that question. Newspapers, magazines, books, radio, and television give us a lot of advice about what we should or should not eat. Unfortunately, much of this advice is confusing.

Some of this confusion exists because we do not know enough about nutrition to identify an "ideal diet" for each individual. People differ, and their food needs vary depending upon age, sex, body size, physical activity, and other conditions such as a spinal cord injury. Some guidelines for "healthy" people are listed below.

• Eat a variety of foods.
• Maintain ideal weight.
• Avoid too much fat, saturated fat, and cholesterol.
• Eat foods with adequate starch and fiber.
• Avoid too many sweets.
• Avoid too much sodium.
• If you drink alcoholic beverages, do so in moderation.

EAT A VARIETY OF FOODS

You need about 40 different nutrients to stay healthy. These include vitamins, minerals, protein, carbohydrates, fats, and water. These nutrients are in the food you eat.

No single food item supplies all the essential nutrients that your body needs. Therefore, you should eat a variety of foods to ensure an adequate diet.

MAINTAINING AN IDEAL WEIGHT

If you are too heavy, your chances of developing some chronic disorders are greatly increased. Obesity is associated with diabetes, high blood pressure, and increased levels of blood fats. This can lead to atherosclerosis (ath-urr-oh-sklurr-OH-siss) or hardening of the arteries. These can increase your risk of having heart attacks or strokes. Obesity also increases your risk of developing pressure sores, impairs mobility, and makes transfer difficult.

If you are underweight, you may have a decreased ability to fight infections and may tire more easily. You may also be at risk for development of pressure sores. Being underweight is also associated with a shortened lifespan.

Therefore, try to maintain your "ideal" weight. But how do you determine what is an ideal weight for you? There is no absolute answer for this, but table 8.A lists acceptable weight ranges for most people with SCI. Ask your doctor or dietitian what your ideal weight is after your spinal cord injury.

TABLE 8.A. Acceptable Weight Ranges

 
Weight Loss

Do you need to lose weight? If so, you must take in fewer calories than you burn. This means that you must either select foods containing fewer calories, or you must increase your activity, or both. Listed below are some ways to help you lose weight.

• Limit the size of your food portions.
• Avoid second servings.
• Eat slowly, allowing at least 20 minutes per meal.
• Enjoy every bite.
• Make eating a separate activity.
• Try not to skip breakfast or lunch and try to avoid overeating at dinner.
• Avoid using food as way of dealing with boredom, anger, fatigue, or anxiety.
• Consciously choose food with a view to its nutritive value.
• Avoid keeping high-calorie, low-nutrient snacks around the house.
• Eat less fat and fatty foods.
• Eat less sugar and sweets.
• Eat only when you are hungry.
• Be active.
• Know the danger period during the day when you tend to overeat. Be prepared with other alternatives.
• Be forgiving. No one is perfect. If you fall off your diet one meal or day, compensate by eating less the next meal or day.

Lose weight gradually to allow your body to adjust to the change. One to two pound weight loss per week is safe. If you lose weight gradually, you are less likely to regain the weight when you reach your goal. Long term success depends upon the development of new and better habits of eating and exercise. If you desire to lose weight, your dietitian can help you plan a diet that meets your individual needs.

 
Weight Gain

If you need to gain weight, do so gradually. A steady gain of one to two pounds per week will allow your body to increase in muscle mass and not just fat. Listed below are some ways to help you gain weight.

• Consume at least three balanced meals per day.
• If you have a decreased appetite, eat six small meals per day.
• Eat foods that have higher fat content, such as whole milk, milkshake, or eggnog; raw vegetables with dip; cream soups.
• Add extra margarine, peanut butter, jelly, or jam to bread and crackers.
• Use thick gravies and cream sauces.
• Eat high-calorie snacks between meals such as dried fruit, nuts, ice cream, and milkshakes. If you are busy during the day, carry your snacks with you.
• Make mealtime as pleasurable and relaxed as possible by planning your meals ahead of time and eating with a friend. Avoid arguments during mealtime.
• Prepare foods that look good and are tasty.
• Eat foods that fill you up quickly at the end of the meal. For example, liquids and high fiber foods (salads, vegetables, fruits).

 
AVOID FAT AND CHOLESTEROL

Both saturated fat and cholesterol are known to increase your risk of developing heart disease.

• Saturated fats are fats that harden at room temperature, such as butter. They are found in animal products and in coconut, palm, and other vegetable oils that have been converted to a saturated fat through a process called hydrogenation (high-DRAHJ-in-AY-shun).
• Cholesterol is a wax-like substance found in every cell of the body. It is an essential component of cell membranes. It is found in food that comes from animal sources. However, it is not required in our diet because our liver makes all we need.

 
How to Avoid Too Much Fat, Saturated Fat, and Cholesterol

• Choose lean meat, fish, poultry, dry beans and peas as your protein sources.
• Moderate your use of eggs (to three per week or less) and organ meats (such as liver).
• Limit your intake of butter, cream, hydrogenated margarine (solid margarine), shortenings, coconut oil, and food made with these products.
• Trim excess fat and skin off meats.
• Broil, bake or grill rather than fry food.
• Read labels carefully to determine both amounts and types of fat contained in foods.

 
EAT FOODS WITH COMPLEX CARBOHYDRATES AND FIBER

The primary sources of energy in the average U.S. diet are carbohydrates and fats. If you limit your fat intake, you should increase your daily amount of complex carbohydrates to supply your body’s energy needs.

In trying to reduce your weight to "ideal" levels, carbohydrates have an advantage: they contain less than half the number of calories per ounce than fats.

Complex carbohydrate foods are better for you than simple carbohydrates. Simple carbohydrates such as table sugar, syrup, and honey provide calories but little else in the way of nutrients. Complex carbohydrates such as beans, peas, nuts, seeds, fruits, vegetables, whole grain breads, and cereals contain fiber and many essential nutrients in addition to calories.

The average American diet is relatively low in fiber. Fiber (roughage, bulk) is a strand-like material. It cannot be digested by the human stomach because it resists digestive enzymes. Therefore, fiber helps you with your bowel program and keeping you regular. Regularity can be a problem for people with a spinal cord injury.

To make sure you get enough fiber and complex carbohydrates in your diet, you should eat fruits and vegetables, whole-grain breads, and cereals. Example of foods that are high in fiber are listed below:

 
Breads and Cereals

• All bran cereals, some cereals with whole wheat or raisins, whole wheat bread or whole rye bread, cracked wheat bread. Read the labels on cereal boxes.
• Brown or unpolished rice.
• Potatoes, baked or boiled in their skin.
• Cracked wheat, barley and millet.

Fruits

• Fresh oranges, apples, pears, papaya, watermelon, all types of berries, grapes, peaches, plums.
• Dried fruits, such as raisins, prunes, peaches, apricots, dates, figs.

Vegetables

• Cabbage, celery, chicory, cucumbers, escarole, lettuce, tomatoes, carrots.
• Cooked vegetables, such as all types of beans, greens (beet, mustard, collard), broccoli, kale, squash, brussels sprouts, corn.

Legumes, Nuts and Seeds

• Soybeans, kidney beans, lima beans, split peas, walnuts, peanuts, sunflower seeds, pumpkin seeds.

 
AVOID TOO MANY SWEETS

The major health hazard from eating too many sweets is tooth decay, but other concerns are that sweets are high in calories and low in the amount of nutrients that your body needs. Therefore, if you need to lose weight, limit the amount of sweets in your diet.

If you do not need to lose weight, sweets may be added to your diet after you have consumed the amount of servings recommended in the food guide pyramid.

 
How to Avoid Excessive Sugars and Sweets

• Use less of all sugars, including white sugar, brown sugar, raw sugar, honey and syrups.
• Eat less of foods containing these sugars, such as candy, soft drinks, cakes and cookies.
• Select fresh fruit or fruits canned without sugar or with light syrup rather than heavy syrup.
• Read food labels for clues on sugar content. If the words sucrose, glucose, maltose, dextrose, lactose, fructose or syrups appear first, then there is a large amount of sugar.
• Remember, how often you eat sugar is as important as how much sugar you eat.

 
AVOID TOO MUCH SODIUM

Table salt contains sodium and chloride; both are essential elements. Too much sodium, however, is a hazard for people who have high blood pressure or heart disease. It also can cause edema (swelling due to water retention).

Sodium is present in many beverages and foods that we eat, especially in certain processed foods, condiments, sauces, pickled foods, salty snacks and sandwich meats. Baking soda, baking powder, monosodium glutamate (MSG), soft drinks, and even many medications (many antacids, for instance) contain sodium. Therefore, it is not surprising that adults in the United States take in much more sodium than they need. Since most Americans eat more sodium than is needed, consider reducing your sodium intake. Use less table salt. Eat sparingly foods to which large amounts of sodium have been added. Remember that up to half of your sodium intake may be "hidden", either as part of the naturally occurring food or, more often, as part of a preservative or flavoring agent that has been added.

 
How to Avoid Too Much Sodium

• Learn to enjoy the unsalted flavors of foods.
• Cook with only small amounts of added salt.
• Add little or no salt to food at the table.
• Limit your intake of salty foods, such as potato chips, pretzels, salted nuts and popcorn, condiments (soy sauce, steak sauce, garlic salt), cheese, pickled foods, cured meats.
• Read food labels carefully to determine which foods have sodium in them.
• Use herbs and spices to season your food. Go lightly--a little goes a long way. Enhance the food flavor, don’t overwhelm it! Start with a quarter teaspoon per four servings. Some common spices and their uses are listed in Table 8.B.

TABLE 8.B. Alternative Seasonings to Use Instead of Salt

 
DRINK ALCOHOL IN MODERATION ONLY

Alcoholic beverages tend to be high in calories and low in other nutrients. Even moderate drinkers may need to drink less if they wish to achieve ideal weight.

On the other hand, heavy drinkers may lose their appetites for foods containing essential nutrients. Vitamin and mineral deficiencies occur commonly in heavy drinkers - in part because of poor intake, but also because alcohol alters the absorption and use of some essential nutrients.

Heavy drinking may also cause a variety of serious conditions, such as cirrhosis (sir-ROW-sis) of the liver and some neurological disorders. Cancer of the throat and neck is much more common in people who drink and smoke than in people who do not. If you drink, you should do so in moderation.

 
Moderation

• One or two 6-ounce glasses of wine.
• One or two 12-ounce bottles of beer.
• One or two 1-ounce shots of 80-proof hard liquor.

 
RESOURCES

 
Web Sites

www.eatright.org
This web site is maintained by the American Dietetic Association (ADA), the world's largest organization of food and nutrition professionals. The site includes food and nutrition news, a marketplace, nutrition resources, "find a dietitian", and other information. The ADA promotes nutrition, health, and well-being. It publishes the Journal of the American Dietetic Association, a monthly journal on food and nutrition topics for professionals and consumers. Its programs include government affairs, which monitors food and nutrition-related regulations and legislation; education and registration for nutrition professionals; information on insurance coverage for nutrition services; and a nutrition hotline. The hotline, at (800) 366-1655, provides recorded messages on nutrition topics and referrals to dietitians.

American Dietetic Association
216 W. Jackson Boulevard
Chicago, IL 60606-6995
(312) 899-0040

www.mayohealth.org
This is Mayo Clinic’s Health Oasis, maintained by the Mayo Foundation for Medical Education and Research. Health Oasis provides information about patient care, research, and education programs. The website’s Nutrition button offers news, a reference library, recipes, a searchable cookbook, food quizzes, and more.

Mayo Clinic
200 First Street, SW
Rochester, MN 55905
(507) 284-2511
TTY (507) 284-9786

www.navigator.tufts.edu
Tufts University Nutrition Navigator, a Rating Guide to Nutrition Websites, is maintained by the Center on Nutrition Communication of Tuft’s School of Nutrition Science and Policy. As a response to the proliferation of websites offering nutrition advice, the Tufts advisory panel reviews and rates websites for their content (accuracy, depth of information, frequency of updates) and usability. Sites can receive a ranking up to 25; sites that rank below a certain level on accuracy will not be listed. The ADA site received a rating of 23; the Mayo Clinic site 25.

 

SCI Self-Care Guide Main Page Chapter 1     SCI Anatomy & Physiology Chapter 2     Skin Care Chapter 3     Circulatory System Chapter 4     Respiratory Care Chapter 5     Range of Motion Chapter 6     Bladder Management Chapter 7     Bowel Management Chapter 8     Nutrition Chapter 9     Medications Chapter 10   Nerves, Muscles, and Bones Chapter 11   Autonomic Dysreflexia Chapter 12   Pressure Sores Chapter 13   Psychosocial Adjustment Chapter 14   Sexual Health & Rehabilitation

Chapter 15   Community Resources Chapter 16   Vocational Rehabilitation Chapter 17   Recreation Chapter 18   Driver’s Training Chapter 19   Attendant Management Chapter 20   Home Modifications Chapter 21   Approaching Discharge Chapter 22   Pain after Spinal Cord Injury Chapter 23   Substance Abuse and SCI Chapter 24   Exercise Chapter 25   Alternative Medicine Chapter 26   Equipment Chapter 27   Staying Healthy Glossary